Clincal Research Of Endovascular Angioplasty And Stenting In Symptomatic Middle Cerebral Artery Stenosis

Objective:Stroke is located in the top of mortality, morbidity and disability in China,and its has been on the rise year by year,bringing huge burden to the society and family.Atherosclerotic interacranial arterial stenosis is one of the most causes of stroke worldwide,especially in Black, Asian, and Hispanic populations compared with White.The Middle cerebral artery(MCA) is the most easily affected artery of intracranial arterial stenosis and one of the important reasons for the cause of ischemic stroke. Middle cerebral artery is a direct continuation of internal carotid artery, the trunk gives off many cortical branches and perforating artery, the former supplies two thirds of the outer side of the cerebral hemispheres, including frontal lobe, parietal lobe, temporal lobe and insula,the latter supplies the knees and two-thirds hindlimb of internal capsule, putamen, globus pallidus and caudate nucleus. Middle cerebral artery stenosis cause corresponding hemodynamic disorders and stroke risk increases. Acute occlusion is more likely to lead to large area infant,and even death. The traditional therapies for symptomatic middle cerebral artery stenosis include antiplatelet aggregation, anticoagulation, controling blood pressure,lowering lipidprotein and solidifing spots by statins. Despite the positive medical treatments,the risk of ischemic stroke to patients who have symptomatic middle cerebral artery stenosis in one year still account for 41.1% of interacranial arterial stenosis. Recently, since the appearance of intracranial dedicated stent with good compliance and support, the advent of Endovascular angioplasty and stenting as effectively preventing ischemic stroke caused by interacranial arterial stenosis has been extensively developed at home and abroad. Despite the latest SAMMPRIS study has not proved that endovascular angioplasty and stenting is superior to the positive medical management, for those who do not achieve ideal outcome with the positive medical management, endovascular angioplasty and stenting is still effective and important means of prevention and treatment of stroke at present and in the future.The study aims at exploring the supply of endovascular angioplasty and stenting in the treatment of symptomatic middle cerebral artery stenosis, observing the probability of stenting success, complication rate, the stenosis degree before and after treatment, and following up therapeutic effect.Methods:Collected patients with ischemic cerebrovascular disease who had been accepted treatment in No.2 Affiliated hospital of Hebei medical university before October 2014, including acute cerebral infarction(ACI) or transient ischemic attack(TIA).Included:(1)cerebral angiography confirmed MCA M1 segment stenosis ≥70%, or>50% having refractory ischemic symptoms;(2)the lesions occur in the side of the MCA blood supply zone for TIA or cerebral infarction.(3) patients had at least one risk factor of atherosclerosis;(4)by postive medical treatment, clinical symptoms showed no improvement, repeated attacks or progression;(5) the patient and family signed informed consent; Excluded:(1) non atherosclerotic vascular stenosis, arteritis, artery clamp, moyamoya disease, etc.;(2)stroke pssibility caused by cardiac embolism;(3) perforating artery infarct caused by atherosclerotic plaques covering the perforating artery open;(4) within 30 d cerebral hemorrhage or hemorrhagic infarction, 6 weeks happened in the area of a third or more middle cerebral artery blood supply area cerebral infarction; Intracranial tumor, aneurysm, arteriovenous fistula;(5) and severe heart valve disease, atrial fibrillation, heart mural thrombus, within 6 weeks myocardial infarction, severe lung disease or expected survive time < 1year;(6) the stenosis is tortuous coronary seriously, or its length>1.5 cm;(7) patients cannot accept antithrombotic therapy. A total of 31 patients(21 male and 10 female; mean age48 ±11.0 years).Complete sufficient preoperative preparation and do endovascular angioplasty and stenting. Detailed record the clinical information, imaging data, operation records, observe the probability of stenting success, complication rate, the stenosis degree before and after treatment, and following up therapeutic effect.Results:1 Treatment and Technical success rate of stenting treatmentA total of 31 patients successfully received stenting treatment,including Gateway-Wingspan self-expanding stents in 1.6 cases, Apollo balloon-expandable stents in 15 cases. Posttreatment residual stenosis rate was less than 50%, treatment success rate was 100%(31/31); after 3 days, in-stent subacute thrombosis happened in 1 case, no death patient, technical success rate was 96.8%(30/31).Neurological complications happened in 1 case, its incidence was 3.2%(1/31).2 The average degree of target stenoses before and after the treatment.Patients stenosis rate before treatment was 81.8± 6.4% on average, its residual stenosis rate after treatment was 4.4±6.2%, stenosis was significantly improved. Statistical analysis, there had a statistically significant difference in compared with before and after(α = 0.05, P<0.01).3 Restenosis.Following-up was done in the group of 31 patients,8 cases review cerebral CTA, and 6 cases for cerebral DSA, restenosis occurred in 2 cases, the incidence of restenosis was 14.2%(2/14), including symptomatic restenosis 1 case, the rate was 7.1%(1/14).4 End Points and Other Major Adverse Events.After following-up in the 31 patients, perioperative:at one day after treatment 1 case occured upper gastrointestinal hemorrhage;three days after treatment, in-stent subacute thrombosis occured in 1 case; 28 days after treatment, ischemic stroke in territory of qualifying atery happened in 1 case; Perioperative efficacy end point event rate was 6.5%(2/31), and the incidence of neurological complications was 3.2%(1/31). Follow-up of 3 months efficacy end point events cumulative incidence was 12.9%(4/31). Follow-up of 1 year efficacy end point events cumulative incidence was 14.3%(3/21).Conclusion:Endovascular angioplasty and stenting in the treatment of symptomatic MCA stenosis has good security, treatment success rate is high; Perioperative complications incidence is low. After treatment,MCA stenosis rate significantly decreased, narrow degree significantly improved. Posttreatment incidence of restenosis and symptomatic restenosis were low. Long-term follow-up of patients with efficacy end point events rate is low, and no adverse events occurred. Endovascular angioplasty and stenting in symptomatic middle cerebral artery stenosis is safe, feasible and effective.